Making recovery a fun-to-play ‘game’

The last place you might expect to find a former Disney imagineer and an artist is in a university’s neuroscience laboratory, especially when they are playing around with a computer-simulated dolphin named Bandit.

But they are part of a unique line-up of professional disciplines that are combining to galvanise brain repair after a stroke through the use of computer gaming.

The unlikely team, known as the KATA project and headed by Omar Ahmad, was drawn together by Cambridge-educated neurologist and neuroscientist John Krakauer at the US Brain, Learning, Animation and Movement lab he runs at the Johns Hopkins University in Baltimore.

Its BLAM acronym and bold comic-style logo demonstrates a radical approach to human biology, and it could be heading towards one of the biggest breakthroughs in the history of stroke treatment.

His belief is that insufficient stimulation is available for stroke victims in the crucial early weeks post-stroke when the brain has heightened plasticity and, therefore, an enhanced ability to reorganise in response to training. It is a narrow window, lasting maybe weeks and rarely beyond three months.

“And what do we do? We know that patients spend around 60 per cent of the first two weeks alone in their room and 85 per cent of the time not moving. Hospitals can be the most sterile and drab places,” he says. “We know that people watch sport, animated movies and love car chases. We are obsessed with movement and entertainment, yet we suck all of that out of the hospital environment.”

With the support of an exoskeletal arm, patients control its exquisite movements – fashioned after hours of observing real dolphins

With the support of an exoskeletal arm, patients control its exquisite movements – fashioned after hours of observing real dolphins in Baltimore’s National Aquarium – on a large screen and Dr Krakauer believes that joyful immersion in the game could lead to a reversal of impairment.

“We know that dose and intensity of practice matters, but you get perhaps less than an hour a day of arm movement in hospital. This game provides intense motivated play at a time when it is most crucial,” he adds.

“Why should the patients have something less stimulating than a first-class Disney-quality movie?”

BLAM and KATA are now using the animal simulation in a two-year clinical trial that could present groundbreaking results.

“We don’t know yet if we can get patients to recover more than with conventional rehabilitation, but in the first three months the brain has a heightened degree of plasticity, meaning it responds more to training than it will later. We hope we can make a difference with gaming as a therapeutic tool after stroke,” says Dr Krakauer.

Bandit can leap 20 feet high in its virtual world and its pirouettes are balletic, while it also needs sharp movements to evade predators. Stroke patients, using an exoskeleton arm sling to aid control, enjoy its high gaming quality so they do not feel like they are labouring at a rehabilitation chore.

“We have run it with a dozen patients and they are like children again, laughing, playing, completely engrossed,” says Dr Krakauer. “The research is compelling and the early phases have been inspiring so we are entering and exciting period now.”

BLAM and KATA have already moved on to its next game – a half-ant, half-car creature that is controlled on increasingly difficult courses used to track longitudinal skill learning. Dr Krakauer and Dr Ahmad remain committed to PIXAR-quality productions that could make gaming the game-changer in stroke recovery and potentially a host of other diseases.

Their research will pile up on the growing evidence of the benefits of computer stimulation as a therapy.

The Stroke Association is harnessing technology in an innovative social networking project called My Stroke Guide which knits strands of recovery by encouraging users to search for information, link up with others and set goals.

It is running as a pilot project for 200 patients, but is already helping recovering patients to build confidence, achieve physical targets and avoid isolation.

“The feedback has been very positive and it is working well with goal-setting which is an important part of recovery,” says Kristina Barrick, business manager for My Stroke Guide.

“There is a real information gap for stroke survivors and this allows them to find the material they need rather than having lots of leaflets dished out when they leave hospital.

“We have lots of people at different stages of their recovery using it and even have a former IT guy using it as a route to get back to work.”

Technology has a huge role to play in stroke recovery and many will be waiting to see if a dolphin called Bandit can pilot the way to a new era of therapy.

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